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Minnesota health exchange, as expected, encounters a few ‘hiccups’

Early MNsure issues involve a dual-tier payment system for the system’s “helpers,” and a blackout on rate information until October.

MNsure expected to serve about 1.3 million Minnesotans, or one-in-five people in the state.
REUTERS/Andrew Kelly

State lawmakers and officials have already run into “hiccups” this summer implementing MNsure, the health insurance exchange crafted by the Legislature this year.

While such bumps in the road have been numerous — and even expected — since the exchange’s tumultuous beginnings, those working on the ambitious project say they are excited to move forward with the biggest health insurance reform in Minnesota in decades.

This summer, exchange staff members are working to meet key federal IT deadlines to build and test the physical infrastructure of the health insurance marketplace.

They are also working on plans to publicly promote the exchange and reach the hard-to-insure populations that are expected to receive coverage under the state-based backbone of the federal health care reform law.

New board playing catch-up

The seven-member board that Gov. Mark Dayton appointed in April is “drinking from a fire hose” of information to catch up with the fast-moving exchange developments before it takes over final authority of the marketplace at the end of the summer, said the board’s newly elected chairman, Brian Beutner.

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Officials say they expect the exchange to begin enrolling Minnesotans by the federally mandated October deadline. The marketplace must be fully operational by January.

So far, though, this month consumer advocacy groups have criticized what they call a dual-tiered approach for payment to organizations and individuals that will help Minnesotans access insurance coverage options.

Some groups and at least one key lawmaker have also raised concerns that consumers won’t know until October how much coverage will cost under the exchange. It’s expected to serve about 1.3 million Minnesotans, or one-in-five people in the state.

The design and testing of the exchange’s IT infrastructure has also remained a key concern, and officials have noted that it’s unprecedented for such a complicated project to operate under such strict deadlines.

Exchange Director April Todd-Malmlov said the state has stayed on schedule.

“We should have concern when we’re jumping into something that’s new,” said chairman Beutner, a former UnitedHealth Group executive. “I’m excited to deal with the hiccups that will come, because we know nothing’s going to be perfect out of the box.”

Funding disparities an issue

For now, there are disparities in funding for advocates who will help enroll Minnesotans on the exchange.

One of the key goals of the exchange is to expand coverage for at-risk and hard-to-reach populations who have been difficult to insure in the past. Advocates argue that the more people with insurance coverage, the less strain it puts on the overall system.

That translates to lower overall costs and better care for consumers.

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“This is about actually increasing health and also reducing the racial disparities in health that we have,” said Sarah Greenfield, health-care program manager at TakeAction Minnesota.

As the current system stands, the state will pay $70 per individual for “consumer assistance partners” to help enroll Minnesotans in commercial health plans. But advocates will only receive $25 per person to assist low-income enrollees who must use Medicaid, the state-federal assistance program.

Greenfield, of TakeAction, a coalition of progressive groups, criticized such a system and said her organization is working to ensure more parity.

Some estimates put the cost of insuring low-income enrollees at about $300 per person, she said, which leaves a huge gap between available funding and the real cost of what advocates are attempting to accomplish in the first place.

Right now, multiple funding sources are in place to fund advocates who will assist Minnesotans with purchasing insurance, and that’s where the disparities arise, said Malmlov.

She said the state hopes to change the current situation after 2014, calling it a “transition year.”

“Somebody won a battle to create this thing called ‘navigators,’ but then they lost the battle to fund it,” Greenfield said, referring to programs to assist the public with obtaining coverage. “We and the federal government are still dealing with the repercussions of that.”

But Greenfield did praise the grant funding that’s available for organizations to help enroll people in the exchange. The state announced the funding at the end of May and will stop accepting applications in mid-July.

Public outreach in the works

Exchange staff members are focused on public outreach, which will be integral to enrolling hard-to-reach populations.

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Malmlov said a call center aimed at helping the public learn more will be up and running in early September.

“It’s really kind of starting to get the message out and getting the public engaged before open enrollment,” Malmlov said.

Another “hiccup” that’s arisen involves the rates for coverage on the exchange. Right now, state law prohibits the specific costs from becoming public until October.

DFL Rep. Joe Atkins, who crafted the exchange legislation, has urged the state Commerce Department to make a summary of the rates public.

Atkins sent a letter on Friday to Commerce Commissioner Mike Rothman reiterating that rate summaries should be made public to better inform consumers and companies planning to offer coverage on the exchange.

The statute is meant to stop companies from undercutting each other, Atkins said. But he argues that it wasn’t the Legislature’s intention to stop summary information from being public.

“I ought to know,” he wrote. “I was the chief author.”

So far, Atkins said he hasn’t received any complaints about releasing the rate information from the carriers or other state officials, including the exchange.

“As consumers go to purchase from this new entity called MNsure, it would be good from an awareness standpoint for them to have a sense before Oct. 1 what’s going on,” he added in an interview.

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Atkins is also part of a legislative oversight committee that will be meeting over the summer to review how the exchange is shaping up.

He said he expects the committee to review the complex IT procedures, discuss the rate issue, the status of the grants and the in-person assistance funding disparities.

Discussion of the rate issue could come in mid-July in a separate forum.

At the next MNsure board meeting, members are expected to hear about IT development that state staff and outside venders are rushing to complete and test.

“It’s a lot to get up in a short period of time,” Malmlov said. “We’re going to have a shorter timeline for testing than most people would probably like.”

Minnesota Management and Budget Commissioner Jim Schowalter, who will turn over formal authority to the board at the end of the summer, said he expects the transition to go smoothly.

“It’s a great set of issues,” Schowalter said, reflecting on the transition. “I cannot think of a bigger set of challenges that have come across state government.”